With Government/doctor politics dominating the media’s health agenda in recent times, other stories easily to slip past without much fanfare. One such example was the report on the BBC that one million pounds was being invested by researches to identify why patients disregard their doctor’s advice.
It is believed that up to half of medications prescribed for long term health conditions are not taken properly. One of the most obvious costs of the failure to follow advice is the direct waste of providing these medications. In addition, patients fail to control or resolve their health issues with the heightened risk of complications. This inevitably leads to more appointments with their clinician with the associated costs that this involves. Failure to follow their doctor’s advice leads to poorer health outcomes and inconvenience for patient, impacts on the doctor’s availability to others, waste’s money on unused medications and ultimately causes dissatisfaction and frustration all round. Investment of £1 million in that context seems to make sense.
It will be interesting to read the project’s conclusions when they are available, as this will be a great help to clinicians. If we understand the reasons then we can adapt to make improvements. In the meantime the reasons for ‘non-compliance’ that we use as a basis for discussion during our Advanced Patient Communication Skills Course can provide useful guidance.
In a study from 1990, Sokol et al concluded the three key reasons for non-compliance to be:
- Reason 1 – The patient does not understand what they are supposed to do
- Reason 2 – The patient knows what to do but chooses not to
- Reason 3 – The patient knows what to do but is unable to act upon the advice
In the first case, the most obvious cause would be that the patient has genuinely not been given the information they require. However this category also includes where the patient has not ‘heard’ the advice for some reason – even when they have been told. The message may have been too complicated, didn’t make sense or could have been delivered at a time when they were stressed or distracted.
The drivers of the second reason, where the patient knows what to do but chooses not to, are distinctly different: “It won’t happened to me”; “It’s not that bad”; “I don’t want to” or even “I don’t agree with the advice” are all possibilities here.
In the third category, where the patient knows what to do but is unable to follow the advice, the challenges range from difficulty breaking old habits, remembering when to take the treatment, struggling to fit it into their lifestyle or even be due to physical limitations.
The first step to resolving any one of these issues is to identify what is at the root of the problem. Once clarified, the appropriate conversation will differ significantly for each situation.
It will be interesting to see how the output of this new £1 million study differs from this model.
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